tbuckley/cabot-search huggingface dataset:
Abstract 10321: Safety of Catheter Ablation Therapy for Atrial Fibrillation in Cardiac Amyloidosis
Authors: Hassan A Alhassan, Harriet Akunor, Aleesha Kainat, Joseph Donohue, Scott Baumgartner, Samir Saba, Sandeep Jain, Prem Soman
Journal: Circulation (2022)

Introduction: Despite a high burden of atrial fibrillation (AF) in cardiac amyloidosis (CA), the safety of catheter ablation therapy (CAT) in CA is not well established. We sought to examine short-term safety outcomes following CAT for AF in patients with CA compared to matched patients with dilated cardiomyopathy (DCM). Methods: Using data from National Inpatient Sample (NIS), we identified all hospitalizations for AF CAT from the fourth quarter of 2015 through 2019. We matched CA to DCM admissions in a 1:5 ratio using propensity scores based on sociodemographic, clinical comorbidities, and hospital characteristics. We compared in-hospital outcomes including mortality, procedural complications, discharge disposition, total charges, and length-of-stay Results: Overall, 1,395 unweighted hospitalizations (representing 6,750 national hospitalizations) for AF CAT were included in analysis, out of which 45 (3.2%) were admissions for CA. Compared to DCM, CA patients were older (72.9years vs 65.1years), had a higher burden of prior stroke (20.0% vs 8.6%) and chronic kidney disease (53.3% vs 33.6%), and were less likely to have a prior ICDs (4.4% vs 23.0%). We matched 42 amyloid hospitalizations to 210 DCM hospitalizations. After matching, there was no difference in rate of in-hospital mortality (0.24 vs 0.33%, p=0.77), home disposition (97.6% vs 96.2%, p=0.65), total procedural complications (14.3% vs 10.5%, p=0.60), length-of-stay (3.1 days vs 2.1 days, p = 0.23) and total hospital charges ($137,250 vs $133,910, p=0.24). Conclusions: In this contemporary study of CAT for AF in CA, short-term safety outcomes and complication rates were similar to a propensity-score-matched cohort of DCM. Further studies exploring long-term safety outcomes are needed.
Abstract 10412: Malnutrition Severity is Associated With Worse Outcomes in Patients Admitted With Acute Myocardial Infarction
Authors: Mohamad Alhoda Mohamad Alahmad, Kamal gupta
Journal: Circulation (2022)

Introduction: Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. Methods: We used Nationwide Readmission Database (NRD) for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. Results: We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate to severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72-years vs. 75-years, p&lt;0.001) and had more women (48% vs. 37%, p&lt;0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p&lt;0.001). Malnourished patients also had significantly higher inpatient mortality (12.5% vs. 4.6%, p&lt;0.001), length of stay (mean of 13 days vs. 7 days, p&lt;0.001), and all-cause 30-day readmission rates (19% vs. 13%, p&lt;0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs. 0.6%, p&lt;0.001). Univariate analysis showed that the severity of malnutrition also correlated with higher inpatient mortality (OR 2.34[2.24-2.46] for mild malnutrition and 3.65[3.49-3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization presence of malnutrition and severity of malnutrition continued to be associated with higher inpatient mortality compared to those without malnutrition (OR 1.20[1.14-1.26] for mild malnutrition and OR 1.69[1.61-1.78] for more severe malnutrition). Conclusions: In patients hospitalized with AMI, underlying malnutrition is associated with worse outcomes. The severity of malnutrition also correlates with worse outcomes.
Abstract 10999: Long-Term Outcomes of Atrioventricular Valve Regurgitation and Repair in Patients With Single Ventricle Physiology
Authors: Jennifer L Smerling, Andrew B Goldstone, Emile Bacha, Leonardo Liberman
Journal: Circulation (2022)

Introduction: In single ventricle patients, AV valve regurgitation increases the risk of adverse outcomes, and staged palliation with concomitant AV valve intervention further increases that risk in the post-operative period. Long-term outcomes of valve intervention during stage 2 palliation, however, have not been established. The purpose of this study is to evaluate long-term outcomes after AV valve intervention during stage 2 palliation in patients with RV dominant circulation in a multicenter study utilizing a national public-use database. Methods: The study was performed using the SVR and SVR II public use datasets. From the original cohort of 549 patients, 102 (19%) with moderate or severe tricuspid valve regurgitation as measured by their stage 2 pre-operative core lab echocardiogram were included. Kaplan-Meier curves were performed to describe the association between valve regurgitation and intervention and long-term survival up to 6 years post Fontan. Multivariable Cox proportional-hazards models were used to assess the relationship between valve intervention and survival adjusting for confounding covariates. Results: Patients with moderate or severe valve regurgitation at either stage 1 or 2 had worse long-term survival defined as death or transplant up to 6 years post-Fontan operation ( p &lt; 0.001, p &lt; 0.01). There were 34 patients (33%) of the 102 with significant regurgitation who underwent valve intervention at the time of stage 2 repair. Those who underwent valve intervention at stage 2 surgery were significantly more likely to die or undergo heart transplantation (HR 3.49, CI 1.53-7.94). Of the patients who underwent valve intervention, those who survived were more likely to have none or mild valve regurgitation by the time of stage 3 (78% vs 46%, p = 0.025). Patients with moderate to severe AV valve regurgitation at the time of the Fontan had favorable outcomes regardless of valve intervention with 100% survival. Conclusions: The risks associated with AV valve regurgitation in single ventricle patients are not mitigated by valve intervention at the time of stage 2 palliation. In fact, patients who underwent valve intervention at stage 2 had significantly worse survival as compared to patients with AV valve regurgitation who did not.
Abstract 10438: Genetically Determined Levels of Apolipoprotein B and Low-Density Lipoprotein Are Not Associated With Increased Mortality in Heart Failure
Authors: Preet Shaikh, Chenao Qian, Erika Kvikstad, Joseph Maranville, Lei Zhao, Ching-Pin Chang, David A Gordon, Francisco Ramirez-Valle, Ali Javaheri, Julio Chirinos
Journal: Circulation (2022)

Introduction: Increased levels of low-density lipoprotein cholesterol (LDL-C) and its constituent apolipoprotein B (ApoB) are associated with atherosclerotic coronary disease, a risk factor for heart failure (HF). However, among patients with established HF, increased LDL-C has been associated with a lower risk of death. The potential causality of this association is unclear. Hypothesis: This study investigated the relationship between ApoB/LDL-C and adverse outcomes in participants with HF. Methods: We measured ApoB levels using the SomaScan assay among participants in the Penn Heart Failure Study (PHFS, n=1268). We performed one-sample Mendelian Randomization (MR) for ApoB and two-sample MR for ApoB and LDL-C. Results: Measured ApoB levels were inversely associated with the risk of death (Fig 1A) or death and heart failure hospital admission (DHFA; Fig 1B). One-sample MR revealed no significant association between genetically determined ApoB and the risk of death (HR 0.497, [95% CI, 0.20-1.2], p=0.125) or DHFA (HR 0.653, [95% CI, 0.35-1.2], p=0.182). Two-sample MR analyses were also consistent with a non-significant association between ApoB (Fig 2) or LDL-C (Fig 3) and risk of death or DHFA. Conclusions: ApoB is associated with the risk of death or DHFA in established HF. However, MR does not support a causal link between ApoB/LDL-C and the risk of adverse outcomes in this population.
Abstract 10384: Impact of Preexisting Pulmonary Hypertension on Outcomes in Patients Hospitalized With Covid-19
Authors: David Louis, Wasiq Sheikh, Marwan Saad, Phinnara Has, kevin kennedy, Herbert D Aronow, Gaurav Choudhary
Journal: Circulation (2022)

Introduction: Pulmonary hypertension (PH) is commonly associated with cardiopulmonary co-morbidities that increase morbidity and mortality risk with COVID-19. Hypothesis: This study aims to evaluate the association between preexisting PH and in-hospital outcomes in patients admitted with COVID-19. Methods: Consecutive patients at a large New England academic health system hospitalized with COVID-19 between March 1 and December 31, 2020, who had prior echocardiograms with documented estimated right ventricular systolic pressure (RVSP) were included. PH was defined as RVSP ≥30 mm Hg. Multivariable logistic regression adjusting for demographic and clinical characteristics was employed to relate PH to a primary outcome of all-cause mortality, and secondary outcomes including non-invasive positive pressure ventilation (NIPPV), myocardial infarction (MI), intensive care unit admission (ICU), and recurrent heart failure (HF) individually. Results: Of the 656 patients admitted, 395 (60.2%) had documented PH on a prior echocardiogram. PH patients were older, more likely to be men, and have cardiopulmonary and renal disease. Patients with PH had larger atrial size and higher E to early diastolic mitral annular tissue velocity (E/e') but similar left ventricular and right ventricular function compared to patients without PH. All-cause mortality (21% vs 10.3%, p= 0.001), need for ICU level of care (19% vs 13%, p = 0.046), NIPPV (23% vs 16%, p = 0.03), and recurrent HF (18% vs 5%, p &lt; 0.001) were more common in patients with PH compared to those without. Unadjusted and adjusted odds ratios relating PH to study outcomes appear in the Table . Conclusions: Preexisting PH is independently associated with higher risk of all-cause mortality in patients who are hospitalized with COVID-19.
Abstract 10977: Shared Decision-Making in Athletes Diagnosed With a Cardiovascular Condition: A Scoping Review
Authors: Heidi Corneil, Kiera Liblik, Sonu Varghese, Bruce Masotti, Nathaniel Moulson, Jimmy McKinney, Katherine S Allan, Amer Johri, Nicholas Grubic
Journal: Circulation (2022)

Introduction: Exercise restriction following the identification of a cardiovascular condition can profoundly impact the identity, career, and well-being of athletes. Shared decision-making (SDM) is emerging as the standard of care to guide recommendations for athletes at risk of cardiovascular events. This scoping review summarizes existing approaches, barriers, and facilitators to SDM in sports cardiology. Methods: A literature search of the MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, SPORTDiscus, and PsycInfo databases was conducted in January 2022. Abstract screening and full-text review were completed in duplicate by independent reviewers. The PCC (Participants, Concepts, Context) framework was used to assess study eligibility. Included articles discussed the use of SDM (C/C) following the diagnosis of a cardiovascular condition in an athlete (P). Results: A total of 6,049 records were screened, of which 38 were included in this review. Article classifications included theoretical papers (31), such as editorials and guidelines, and research studies (7). Main findings of the research studies are shown in Table 1. All selected articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders (e.g., parents, coaches). The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Common themes among SDM approaches emerged, such as emphasizing patient values, considering non-physical factors (e.g., emotional, psychological, financial), and informed consent. Barriers to SDM included pressure from institutions and liability of healthcare providers in the case of adverse events. Conclusions: SDM is the recommended paradigm for providing care to athletes diagnosed with cardiovascular conditions. Further education for healthcare providers regarding the SDM approach, as well as future research assessing SDM in a clinical setting, is needed.
Abstract 11024: 3D Localization of Left Bundle Branch Area and Pacing Lead Orientation During Left Bundle Pacing
Authors: Mahmoud Ali, Andy Kieu, Tarek Ajam, Mohammed Premjee, Lynn Erickson, Imran Niazi
Journal: Circulation (2022)

Introduction: Left bundle branch area (LBBA) pacing is a novel physiologic pacing technique where the pacing lead is inserted through the right ventricular (RV) septum to capture the LBBA. Among the challenges encountered are identifying the RV septal site, assessing the plane of the lead, determining the depth of insertion, and repositioning the lead to a new site if needed. Navik 3D is a unique localization system that can convert 2D fluoroscopy images into 3D. Methods: Following consent, we studied six consecutive patients with a mean age of 72 years who underwent LBBA pacing. Patient characteristics including female sex (n=2), mean body mass index (33.8 kg/m 2 ), mean left ventricle ejection fraction (51%), mean intraventricular diastolic thickness (1.06 cm), and presence of hypertension (n=4), diabetes (n=4) atrial fibrillation (n=4), and left bundle branch block (n=1). Patients presented with either complete heart block (n=4) or sinus node dysfunction (n=2). LBBA was localized on the RV septum using fluoroscopy and contrast injection. The RV septum, RV apex, lead position, and His locations were identified in 3D using 2D fluoroscopy from two different views. Then, 3D locations were projected on the 2D fluoroscopy image via the Navik 3D mapping system. The system could also mark an unsuccessful site and allow repositioning. Results: All patients had a successful placement in the LBBA with qR in V1, short mean left ventricular activation time (ms) in V6 (73.1), and left bundle potential was recorded in 3 patients. Conclusions: Localization of LBBA in 3D is feasible and may be useful for optimal lead placement.
Abstract 10902: The Association of Public-Access Defibrillation Rate With Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With Bystander-Witnessed and Initial Shockable Rhythm During Covid-19 Pandemic in Japan
Authors: Aya Katasako, Yoshio Tahara, Kenichi Tsujita, Teruo Noguchi, Kengo Kusano, Naohiro W Yonemoto, Hiroshi Nonogi, Ken Nagao, Takanori Ikeda, Naoki Sato, Yoshio Kobayashi
Journal: Circulation (2022)

Introduction: On January 16, 2020, the first COVID-19 infectious patient was reported in Japan. Since then, we have faced on the unprecedented COVID-19 pandemic. Initially, the direct mortality caused by COVID-19 had been focused on. However, recently, the pandemic’s indirect negative effects, stagnation of chain of survival, has been seen as a problem. Hypothesis: The negative impact would be particularly large on out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm. Methods: This is a retrospective cohort study from the All-Japan Utstein Registry, which is a population-based and nationwide registry. Primary outcome are survival rate and favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. We identified the association of the use of AED with survival and neurological outcome in patients who had OHCA events, bystander-witnessed and initial shockable rhythm before and after COVID-19 pandemic. Results: We compared the 5,240 OHCA patients with bystander-witnessed and initial shockable rhythm in pandemic period (2020) to the 16,628 of those in non-pandemic period (2017-19). The use of AED was decreased, (22.5 vs 20.3 %, respectively, p&lt;0.001) and the survival rate and the proportion of favorable neurological outcome at 30 days was decreased. (39.3 vs 37.7 %, respectively, p=0.04; 28.7 vs 26.1 %, respectively, p&lt;0.001) In addition, we compared by the regions. In regions of infection spread, the use of AED was decreased (25.9 vs 22.5 %, respectively, p=0.001), and the survival rate and the proportion of favorable neurological outcome at 30 days was decreased. (40.8 vs 36.8%, respectively, p&lt;0.001; 29.5 vs 24.5 %, respectively, p&lt;0.001) However, in regions of infection non-spread, there are no significantly differences in these points. Conclusion: The delay of prehospital intervention may have negatively effected in the survival rate and favorable neurological outcome at 30 days during COVID-19 pandemic.
Abstract 10252: Differences in the Transcriptomic Profile of Visceral Fat in Persons With Metabolically “Healthy” versus Metabolically “Unhealthy” Obesity
Authors: Mariam Meddeb, Risa Wolf, Amelia S Wallace, Xin Chu, Roberta Florido, Justin B Echouffo Tcheugui, Kuni Matsushita, David A Kass, Gary Gerstenblith, Sangwon Kim, Rexford Ahima, G Wood, Josef Coresh, Peter Benotti, G William Wong, Chiadi E Ndumele
Journal: Circulation (2022)

Introduction: There is varied metabolic dysfunction among persons with obesity. We assessed differences in visceral adipose tissue transcriptome between persons with metabolically healthy and metabolically unhealthy obesity. Methods: We studied 40 patients with obesity (mean age 46; median body mass index 46 kg/m 2 ) undergoing bariatric surgery at Geisinger Medical Center. Three obesity groups were defined. Two (metabolically unhealthy) had metabolic syndrome (MetS) with diabetes (DM) (MUOD; n=16) or without DM (MUO; n=8). The third (metabolically healthy) had no MetS or DM (MHO, n=16). Omental adipose tissue obtained at bariatric surgery was snap frozen. Total RNA was extracted and RNA sequencing performed using an Illumina platform. Differential gene expression between the 3 groups was analyzed using DESeq2 software and pathway enrichment analysis performed using Gene Ontology. Results: Using an adjusted P-value &lt;0.05, 134 genes were upregulated and 114 genes downregulated in patients with MUOD versus MHO. Genes with the highest amplitude of transcriptional differences included lipopolysaccharide binding protein with log2 fold change (l2fc) of 2.2 and Padj= 1.6 10 -7 , osteopontin (l2fc= 1.9, Padj=1.6 10 -7 ), chitinase 3 L1 (l2fc= 2.4 Padj= 1.7 10 -4 ), carbonic anhydrase 3 (l2fc= -2.6 Padj= 4.8 10 -8 ) and perilipin 5 (l2fc= -1.2 Padj= 0.003). GO upregulated pathways were enriched for pro-inflammatory pathways including leukocyte migration, responses to lipopolysaccharide and interleukin-1, and T cell activation (Padj= 1.7 10 -13 , 9.89 10 -11 , 4.9 10 -09 , 1.1 10 -08 respectively). Downregulated pathways were enriched in organic acid catabolic process, fatty acid oxidation and oxidative phosphorylation (Padj= 7.7 10 -20 , 8.6 10 -20 , 1.5 10 -09 respectively). An inflammatory signature was also present in MUO compared to MHO, whereas oxidative processes were not downregulated in those with MUO relative to MHO. Conclusion: In patients with class III obesity, we found a heterogeneous visceral adipose tissue transcriptome. A pro-inflammatory signature in visceral fat was found across the metabolic syndrome spectrum. A metabolic signature with decreased oxidative phosphorylation was linked to metabolic syndrome with concomitant diabetes.
Abstract 10997: Reduction in Dietary Saturated Fat Intake Lowers LDL-C but Increases Lp(a) Levels in African Americans: Findings From the GET-READI Randomized Controlled Crossover Feeding Trial
Authors: Enkhmaa Byambaa, Wei Zhang, Heejung Bang, Muhammad Khan, Sina Khazaei, Marlene M Most, Jennifer Rood, Michael Lefevre, Lars Berglund
Journal: Circulation (2022)

Reduction in dietary saturated fatty acids (SFA) intake results in a significant clinically meaningful lowering of LDL-C across ethnicities. In contrast, the role of dietary SFA reduction in modulating emerging risk factors for cardiovascular disease (CVD) in different ethnic groups remains poorly understood. An elevated level of lipoprotein(a) [Lp(a)], an independent casual risk factor for CVD, disproportionally affects African Americans. In this study, we assessed the responses in Lp(a) to dietary SFA reduction specifically in African Americans (N=166) enrolled in GET-READI (The Gene-Environment Trial on Response in African Americans to Dietary Intervention), a randomized controlled feeding trial. Men and women with above optimal LDL-C were fed two diets in a random order for five weeks each: (1) the average American diet (AAD) (37% total fat: 16% SFA), and (2) a diet similar to the Dietary Approaches to Stop Hypertension (DASH) combination diet (25% total fat: 6% SFA). The mean age of participants was 33 years (range: 18-64 years), 70% were women, the mean BMI was 28.4 kg/m 2 and LDL-C was 116 mg/dL. At the end the 5-week intervention period with the DASH diet, compared with the end of the AAD diet, LDL-C was significantly reduced (mean change: -12.4 mg/dL, p &lt;0.0001), as were the levels of total cholesterol (-16.6 mg/dL, p &lt;0.0001), HDL-C (-5 mg/dL, p &lt;0.0001), apoA-1 (-8.7 mg/dL, p &lt;0.0001) and apoB-100 (-5.7 mg/dL, p &lt;0.0001). In contrast, Lp(a) levels were significantly increased following the DASH diet compared to AAD (from a median value of 44 mg/dL with AAD to 58 mg/dL with DASH; mean change: +11.2 mg/dL, p &lt;0.0001). As LDL-C measurements typically include Lp(a)-cholesterol, the “true” LDL-C decrease is estimated at -16 mg/dL, i.e., an underestimation by about 30%. In conclusion, in a large cohort of African Americans, an ethnic group with a high burden of elevated Lp(a), reductions in SFA intake significantly increased Lp(a) while reducing LDL-C. These findings suggest that dietary SFA reduction exerted an opposing effect on the circulating levels of two highly-atherogenic lipoproteins. Future studies are warranted to elucidate mechanism(s) underlying the SFA reduction-induced increase in Lp(a) and its role in CVD risk across population groups.